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Reducing Primary Healthcare Bypass Behaviour: A Discrete Choice Experiment Study Exploring the Preferences for
Xiaodong Dong1,2, Junling Zhao1,2, Ziyin Zhao1,2
1School of Public Health, Peking University, Beijing, China.
The Patient
|November 4, 2025
Summary
Rural Chinese residents prefer county hospital eye care over primary care, but improved health literacy and feedback can increase primary eye care (PEC) acceptance. Addressing patient preferences is key to reducing bypass behavior.
Area of Science:
- Public Health
- Ophthalmology
- Health Services Research
Background:
- Primary healthcare (PHC) bypass is common in low- and middle-income countries, particularly for primary eye care (PEC) in rural China.
- Underutilization of PHC for eye care necessitates understanding patient preferences and care-seeking behaviors.
Purpose of the Study:
- Identify service attributes and patient characteristics influencing rural Xinjiang residents' preferences for PEC.
- Assess health literacy's role in mitigating PHC bypass for eye care.
Main Methods:
- A discrete choice experiment (DCE) surveyed 465 rural adults in Xinjiang, China.
- Six PEC attributes (cost, convenience, organization, provider, frequency, feedback) were evaluated.
- Mixed logit and latent class models analyzed preference heterogeneity and willingness to pay.
Main Results:
- Strong preference for county hospital ophthalmologists, lower costs, shorter travel, and comprehensive feedback.
- PHC-based PEC was less preferred, requiring incentives; enhanced feedback and higher health literacy increased acceptance.
- Latent class analysis identified cost/convenience-sensitive subgroups and a low-engagement subgroup preferring higher-tier care.
Conclusions:
- Strengthening PHC-based PEC requires addressing structural/perceptual barriers via quality improvement, communication, and health literacy.
- Patient-centered service design based on DCE preferences can reduce bypassing and improve equitable eye care access.
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